对慢性便秘患者的个体化干预效果及慢病管理模式的探讨

发布时间：2018-07-27 09:34

【摘要】：目的:对慢性便秘患者进行个体化干预和定期的指导、随访及管理,观察干预前后患者的症状、泻剂的使用情况和病情严重程度的改善情况,从而评价慢性便秘的个体化干预效果,并探讨其慢病管理模式。方法:选取2015年5月--2016年10月就诊于山西医科大学第一医院、符合纳入标准的慢性便秘患者716例,按年龄分为青年组(18-40岁)218例、中年组(41-65岁)312例、老年组(65岁)186例。获得患者“知情同意”后指导其填写“慢性便秘调查问卷表”,据此制定针对患者自身特征的综合的个体化干预方案,方案包括饮食指导、运动指导、排便指导、使用药物指导等多方面内容;应用“慢病管理”理念对患者进行定期管理、随访,每两周一次,时间共6个月,每月以28天计算,随访时填写“排便日记表”以记录便秘症状、伴随症状和泻剂使用情况。以干预前患者的自身症状为对照,评价干预前后患者便秘症状和伴随症状的改善情况、泻剂依赖情况,及病情严重程度改善情况;并在随访管理过程中分析导致便秘的主要原因,及时调整个体化干预方案。结果:1.青年组平均干预起效时间为1.64±0.89月,中年组平均干预起效时间为2.09±0.83月,老年组平均干预起效时间为2.16±0.83月,三组平均干预起效时间无差异(P0.05);2.干预后三组便秘患者排便次数均较前明显增多(P0.001),排便困难程度和粪便性状积分均较前明显降低(P0.01);3.干预后三组便秘患者的腹胀、腹痛、嗳气、口腔异味及纳差等伴随症状也均较前有所缓解(P0.05);4.在不用、偶尔、间断、长期使用泻剂情况四种情况下,干预前后青年组存在明显差异(χ2青=20.14,P0.01),中年组也有差异(χ2中=25.60,P0.01);但老年组干预前后并不存在差异(P0.05);5.干预后中度、重度患者比例下降,轻度患者比例增加:青年组重度便秘患者所占比例下降5.51%,中度患者下降7.8%,轻度患者增加13.30%,较干预前改善(χ2=3.96,P0.05);中年组重度便秘患者所占比例下降8.84%,中度患者下降5.32%,轻度患者增加13.97%,较干预前改善(χ2=4.48,P0.05);老年组重度便秘患者比例下降6.46%,中度患者下降4.84%,轻度患者增加11.29%,也较干预前改善(χ2=3.86,P0.05)。结论:个体化干预的慢病管理模式可有效缓解慢性便秘患者的便秘症状及伴随症状,降低泻剂依赖。
[Abstract]:Objective: to conduct individualized intervention and regular guidance, follow up and management of patients with chronic constipation, observe the symptoms of the patients before and after intervention, the use of laxatives and the improvement of the severity of the disease, so as to evaluate the individualized intervention effect of chronic constipation and explore the management mode of the chronic constipation. Methods: in May 2015, --2016 year, in October. In the first hospital of Shanxi Medical University, 716 cases of chronic constipation were conformed to the standard. 218 cases were divided into young group (18-40 years old), 312 cases (41-65 years old) and 186 elderly (65 years old) in the middle age group. The "chronic constipation questionnaire" was used to guide them to fill in the "questionnaire of chronic constipation". The combined individualized intervention program included diet guidance, exercise guidance, defecation guidance, and medication guidance. The patients were regularly managed with the "slow disease management" concept and followed up every two weeks for a total of 6 months, 28 days per month, and a "defecation diary" to record constipation symptoms during follow-up. The symptoms and laxatives were used. The symptoms of the patients before intervention were compared, the improvement of constipation and accompanying symptoms before and after intervention, the condition of laxative dependence, and the severity of the disease were improved; the main causes of constipation were analyzed during the follow-up management, and the individualized intervention program was adjusted in time. Results: 1. green. The average intervention time of the year group was 1.64 + 0.89 months, the average intervention time of the middle age group was 2.09 + 0.83 months, the average intervention time of the elderly group was 2.16 + 0.83 months, the average intervention time of the three groups was no difference (P0.05). The number of defecation times in the three groups of the three groups increased significantly (P0.001), the difficulty of defecation and the fecal traits in the three groups after 2. intervention. Scores were significantly lower than before (P0.01); 3. after intervention, abdominal distention, abdominal pain, belching, stomatology and disodorness were also alleviated (P0.05) in the three groups of constipation patients; 4. in four cases, which were not used, occasionally, discontinuous, and long laxative, there were obvious differences between the young group before and after intervention (x 2 green =20.14, P0.01), and the middle age group also had Differences (=25.60, P0.01), but there was no difference in the elderly group before and after intervention (P0.05); 5. was moderate, the proportion of severe patients decreased, the proportion of mild patients increased: the proportion of severe constipation in the young group decreased by 5.51%, the moderate patients decreased by 7.8%, the mild patients increased by 13.30%, compared with those before the intervention (x 2=3.96, P0.05); the middle age group was severe. The proportion of the constipation decreased by 8.84%, the moderate patients decreased by 5.32%, the mild patients increased by 13.97%, compared with those before the intervention (x 2=4.48, P0.05), the proportion of the elderly patients with severe constipation decreased by 6.46%, the moderate patients were 4.84%, the mild patients were 11.29%, and compared with those before the intervention (x 2=3.86, P0.05). Conclusion: the mode of chronic disease management in individualized intervention can be found. It can relieve constipation symptoms and accompany symptoms of chronic constipation patients, and reduce laxative dependence.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574.62

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